HIV Stigma among People Living with HIV in Southeast Iran

Document Type : Original Article


1 HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran

2 HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA

3 Communicable and Noncommunicable Disease Department, Kerman University of Medical Sciences, Kerman, Iran

4 Social Determinants in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran

5 Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA



Background: This study aimed to measure internal and external HIV stigma and their associated factors among people living with HIV in the southeast of Iran.
Methods: Using convenience sampling and a standard questionnaire, we recruited 104 HIV-positive patients (40% women) in 2018-2019 from two public clinics in Kerman, Iran. The internal stigma scale ranged from 0-22 and the external stigma scale ranged from 0-11 in which a higher score indicates higher stigma.
Results: The mean internal stigma score was 10.7 (SD: 5.2), and that of the external stigma score was 3.1 (SD: 2.9). In multivariable regression analysis, women (Adjusted (Adj). ᵦ=-3.3; p=0.08), and married people (Adj. ᵦ=-5.5; p=<0.001) experienced less internal stigma. In contrast, those who were a member of support group of PLHIV (Adj. ᵦ=2.8; p=0.04), and those infected by sexual contact (Adj. ᵦ=2.1; P=0.006) experienced a higher internal stigma. Moreover, married people (Adj. ᵦ=-1.4; p=0.01), those with high school or higher education (Adj. ᵦ=-1.7; p=0.002), and those with other transmission routes (Adj. ᵦ=-1.4; P=0.01) experienced lower external stigma.
Conclusions: People living with HIV feel considerable internal and external stigma. Addressing HIV stigma should be tailored based on gender, education, marriage, peer groups, and risk groups as these factors have different effects on stigma experiences.


  1. Oskouie F, Kashefi F, Rafii F, Gouya MM. Qualitative study of HIV related stigma and discrimination: What women say in Iran. Electron Physician 2017; 9(7):4718-24. doi: 10.19082/4718.
  2. Fortenberry JD, McFarlane M, Bleakley A, Bull S, Fishbein M, Grimley DM, et al. Relationships of stigma and shame to gonorrhea and HIV screening. Am J Public Health 2002; 92(3):378-81. doi: 10.2105/ajph.92.3.378.
  3. UNAIDS, 2016; Availabel from:
  4. Nyblade L, Stangl A, Weiss E, Ashburn K. Combating HIV stigma in health care settings: what works? J Int AIDS Soc 2009; 12(1):15. doi: 10.1186/1758-2652-12-15.
  5. Chi P, Li X, Zhao J, Zhao G. Vicious circle of perceived stigma, enacted stigma and depressive symptoms among children affected by HIV/AIDS in China. AIDS Behav 2014; 18(6):1054-62. doi: 10.1007/s10461-013-0649-z.
  6. Dahlui M, Azahar N, Bulgiba A, Zaki R, Oche OM, Adekunjo FO, et al. HIV/AIDS related stigma and discrimination against PLWHA in Nigerian population. PLoS One 2015; 10(12):e0143749. doi: 10.1371/journal.pone.0143749.
  7. Friedland BA, Sprague L, Nyblade L, Baral SD, Pulerwitz J, Gottert A, et al. Measuring intersecting stigma among key populations living with HIV: implementing the people living with HIV stigma index 2.0. J Int AIDS Soc 2018; 21(Suppl Suppl 5):e25131. doi: 10.1002/jia2.25131.
  8. Bharat S. A systematic review of HIV/AIDS-related stigma and discrimination in India: current understanding and future needs. SAHARA J 2011; 8(3):138-49. doi: 10.1080/17290376.2011.9724996.
  9. Iwelunmor J, Airhihenbuwa CO, Okoror TA, Brown DC, BeLue R. Family systems and HIV/AIDS in South Africa. Int Q Community Health Educ 2008; 27(4):321-35. doi: 10.2190/IQ.27.4.d.
  10. Okoror T, Airhihenbuwa CO, Zungu M, Makofani D, Brown DC, Iwelunmor J. “My mother told me i must not cook anymore”—food, culture, and the context of HIV− and AIDS-related stigma in three communities in South Africa. International Quarterly of Community Health Education 2008; 28(3):201-13. doi: 10.2190/IQ.28.3.c.
  11. Moussa AB, Delabre RM, Villes V, Elkhammas M, Bennani A, Ouarsas L, et al. Determinants and effects or consequences of internal HIV-related stigma among people living with HIV in Morocco. BMC Public Health 2021; 21:163.
  12. Mahamboro DB, Fauk NK, Ward PR, Merry MS, Siri TA, Mwanri L. HIV stigma and moral judgement: Qualitative exploration of the experiences of HIV stigma and discrimination among married men living with HIV in Yogyakarta. Int J Environ Res Public Health 2020; 17(2):636. doi: 10.3390/ijerph17020636.
  13. Seyed Alinaghi SA, Paydary K, Afsar Kazerooni P, Hosseini M, Sedaghat A, Emamzadeh-Fard S, et al. Evaluation of stigma index among people living with HIV/AIDS (PLWHA) in six cities in Iran. Thrita 2013; 2(4):69-75. doi: 10.5812/thrita.11801.
  14. Bagchi AD, Holzemer W, Peavy D. Predictors of enacted, internal, and anticipated stigma among PLHIV in New Jersey. AIDS Care 2019; 31(7):827-35. doi: 10.1080/09540121.2018.1554242.
  15. Loutfy MR, Logie CH, Zhang Y, Blitz SL, Margolese SL, Tharao WE, et al. Gender and ethnicity differences in HIV-related stigma experienced by people living with HIV in Ontario, Canada. PloS One 2012; 7(12):e48168. doi: 10.1371/journal.pone.0048168.
  16. Pourmarzi D, Khoramirad A, Gaeeni M. perceived stigma in people living with HIV in Qom. J Family Reprod Health 2017; 11(4):202-10.
  17. Zhang YJ, Fan YG, Dai SY, Li BZ, Xu WD, Hu LF, et al. HIV/AIDS stigma among older PLWHA in south rural China. Int J Nurs Pract 2015; 21(3):221-8. doi: 10.1111/ijn.12254.
  18. Buzi RS, Smith PB, Siceluff A. A participatory learning and action (PLA) approach to enhancing linkage to HIV care among youth. Journal of Adolescent Health 2016; 58(2):S82. doi: 10.1016/j.jadohealth.2015.10.176.
  19. Amuri M, Mitchell S, Cockcroft A, Andersson N. Socio-economic status and HIV/AIDS stigma in Tanzania. AIDS Care 2011; 23(3):378-82. doi: 10.1080/09540121.2010.507739.
  20. Nasirian M, Doroudi F, Gooya MM, Sedaghat A, Haghdoost AA. Modeling of human immunodeficiency virus modes of transmission in Iran. J Res Health Sci 2012; 12(2):81-7.
  21. Wolitski RJ, Pals SL, Kidder DP, Courtenay-Quirk C, Holtgrave DR. The effects of HIV stigma on health, disclosure of HIV status, and risk behavior of homeless and unstably housed persons living with HIV. AIDS Behav 2009; 13(6):1222-32. doi: 10.1007/s10461-008-9455-4.
  22. Mburu G, Ram M, Skovdal M, Bitira D, Hodgson I, Mwai GW, et al. Resisting and challenging stigma in Uganda: the role of support groups of people living with HIV. J Int AIDS Soc 2013; 16(3 Suppl 2):18636. doi: 10.7448/IAS.16.3.18636.
  23. Lennon-Dearing R. The benefits of women-only HIV support groups. Journal of HIV/AIDS & Social Services 2008; 7(1):27-45. doi: 10.1080/15381500802093142.
  24. McLeroy KR, Bibeau D, Steckler A, Glanz K. An ecological perspective on health promotion programs. Health Educ Q 1988; 15(4):351-77. doi: 10.1177/109019818801500401.
  25. Heijnders M, Van Der Meij S. The fight against stigma: an overview of stigma-reduction strategies and interventions. Psychol Health Med 2006; 11(3):353-63. doi: 10.1080/13548500600595327.